The Context of Care in Canada

While these scores (see the accompanying Scorecard for the full criteria and scores for each indicator) are indicative of the state of care policy in Canada, we acknowledge that no single number can reflect the full impact of federal policies on care recipients and paid and unpaid care workers. This report aims to explain the scores assigned to each indicator, but also to explain the differentiated impacts of federal policies on marginalized groups, including especially racialized and Indigenous women and migrant care workers.

The Scorecard findings demonstrate that people living in Canada do not have equal access to care and do not have equal access to the resources needed to receive care, both as workers and within their homes and communities. Policymaking allows the government to provide quality care to those who need it, protect care workers employed in the paid labour force as well as remove structural barriers preventing households and communities from sharing the care workload equally.

At its core, the care environment in Canada is shaped by capitalism, neoliberalism, racism, ableism, sexism and other forms of systemic discrimination. Care decisions made under these systems of oppression produce unequal outcomes. The recommendations put forward in this report seek to challenge elements of these systems to ensure that access to care is equitable throughout society and that the federal government is rising to the task of meeting the care needs of everyone living in Canada now and in the future. To better understand the gaps that this report identifies, the analysis is anchored by a brief summary of some of the ways these systems operate.

Capitalism’s neoliberal agenda of privatization and austerity started in the 1980s and continues to this day, prioritizing profits over the provision of quality care services and care-supporting infrastructure. Decades of research show that for-profit service delivery is associated with substandard care and higher user fees, with negative consequences for the people receiving care and the workers providing it.18 Care-supporting infrastructure is increasingly built and maintained by private companies through public-private partnerships, such as those encouraged by the Canada Infrastructure Bank.19 Only 5 of the 16 policies assessed against this criterion around infrastructure in the Scorecard are primarily (over 80%) government funded and administered. Some care services, such as long-term care homes, are already predominantly privately owned, while others, like health care services in Ontario, are moving toward privatization.20 Mortality rates in private long-term care homes were 25% higher than in publicly owned homes in Ontario during the pandemic.21

Normalized sexist, patriarchal and racist worldviews have solidified the view that care work, especially household labour, is “women’s work.” Despite its essential nature, care work remains highly gendered, overlooked and undervalued. Statistics Canada estimates that the economic value of unpaid household care work in Canada is between $516.9bn and $860.2bn or between 25.2% and 37.2% of Canada’s GDP, which is more than the contribution of the manufacturing, wholesale and retail industries combined. Since women have less status, care work is seen as unskilled and less valuable than other employment, and therefore not worthy of living wages and decent working conditions. Due to insufficient wages and the devaluation of care work, many workers do not consider this type of work desirable, leaving the care sector in a constant recruitment and retention crisis and overrepresented of migrant and racialized women care workers. This coupled with racist immigration policies pushes these women to provide valuable care work often under threat of deportation.

Since paid care work is disproportionately performed by immigrant and racialized workers, care policy must be understood within the broader international context. As more women enter the paid labour force in Canada, the increasing need for care workers is filled by racialized immigrant women.22 Many of these workers come to Canada without their families due to strict immigration and visa requirements, leaving care gaps in their home countries. This process, referred to as global care chains, highlights the importance of broad and intersectional analysis that not only considers the Canadian context but the impact that national policies in Canada can have around the world and for those who are providing care.23 For example, in an attempt to address the nursing shortage in Canada – federal and provincial governments have been actively recruiting foreign-trained nurses from the Global South.24 This situation not only demonstrates government inability to train and retain the health-care staff they need, it poses a risk of depleting a supply of health-care workers in the Global South and worsening already fragile healthcare systems.

The relationship between capitalism and care work is complex, as it is both the driving force behind creating a demand for paid care work and the supply of care workers in Global South countries who have few alternatives in their own context.25 In this Scorecard, only one indicator focuses on migrant workers’ rights; however, we considered whether services and benefits were inclusive of migrant workers when scoring criteria on accessibility and reach. Many benefits, including the Canada child Benefit and Old Age Security are not available to many migrant workers despite them paying taxes, which makes Canadian policies exploitative of workers coming from the Global South to fill essential labour shortages. Ensuring that migrant workers are cared for requires valuing care work by transforming social norms, paying fair wages and providing access to employment benefits, coupled with fundamental changes to immigration policy that do not perceive the Global South as a supplier of cheap labour but rather that prioritize pathways to citizenship as a right and reward for the contributions migrant workers make to Canada’s economy and society.

Although Canada scores well in terms of the provision of care services, understanding the ways systemic racism and ableism operate can help explain why marginalized groups do not receive the same care as other groups in health care and education settings. Throughout Canada’s colonial history and in the present, the health care, education and social service sectors have been sites of violence for marginalized persons. For example, the child welfare system and Residential School system have been used to disrupt Indigenous families and communities and resulted in the deaths of thousands of Indigenous children. 26

Today, multiple reports document the ways stigma and discrimination impact the care received by Black and Indigenous patients in hospitals and other health care settings.27,28 Psychiatric institutions have been and continue to be sites of violence for people with mental illness.29 These are all examples of ways that care infrastructure has been used to the detriment of marginalized groups. Racism and ableism have produced care infrastructure that favours removing, isolating and institutionalizing people rather than supporting them or ensuring their communities are well-resourced to meet their care needs.30 Therefore, while this report recommends investing in publicly funded care services, it also recognizes the historical failures of federal care policies in Canada and suggests offering alternatives to institutionalized care by funding community-based care alternatives.

The federal government must invest in public care services and infrastructure to ensure that care is valued, accessible and affordable to all and to reduce barriers to community-based care networks. In areas that fall within provincial jurisdiction, the federal government can adopt a leadership role by tying funding for provinces to federal standards. This approach has already been applied to expand early learning and child care in the past year. Budget 2021 included an historic investment of $30bn over five years to build a Canada-wide early learning and child care (ELCC) system. In less than a year, bilateral agreements were signed with all 13 provinces and territories, and clear plans have been laid out to deliver affordable, inclusive and high-quality child care within the next five years. While there is room for improvement, these agreements set targets for increases in child care spaces and lower fees, while also promising better wages and training opportunities for the child care workforce Families across Canada have already begun to see significantly reduced child care fees, and the government is closer to achieving its goal of $10-a-day child care by 2026. In December 2022, Nunavut became the first jurisdiction to achieve $10-a-day child care under the Canada-wide system.

Transforming gender roles and promoting gender equality requires addressing discriminatory social norms. Entrenched social norms prevent the equal distribution of care responsibilities between men and women – and to value care work (paid and unpaid), these biases must be addressed. In addition to playing a leadership role in the policy sphere by regulating life-saving care policies and enforcing standards for the provinces to adhere to, the federal government can undertake the important role of shifting social norms and expectations around care work through public campaigns, interventions and the media.